Improvements In VO2peak Research Articles

Sacubitril/valsartan versus enalapril on exercise capacity in patients with heart failure with reduced ejection fraction: A randomized, double-blind, active-controlled study

We included 52 participants with HFrEF with a left ventricular ejection fraction <40% to receive either sacubitril/valsartan (target dose of 400 mg daily) or enalapril (target dose of 40 mg daily). Peak VO2 was measured by using cardiopulmonary exercise testing. Six-minute walk test was also performed. At 12 weeks, the sacubitril/valsartan (mean dose 382.6 ± 57.6 mg daily) group had increased peak VO2 of 13.1% (19.35 ± 0.99 to 21.89 ± 1.04 mL/kg/min) and enalapril (mean dose 34.4 ± 9.2 mg daily) 5.6% (18.58 ± 1.19 to 19.62 ± 1.25 mL/kg/min). However, no difference was found between groups (P=.332 interaction). At 24 weeks, peak VO2 increased 13.5% (19.35 ± 0.99 to 21.96 ± 0.98 mL/kg/min) and 12.0% (18.58 ± 1.19 to 20.82 ± 1.18 mL/kg/min) in sacubitril/valsartan (mean dose 400 ± 0 mg daily) and enalapril (mean dose 32.7 ± 11.0 mg daily), respectively. However, no differences were found between groups (P= .332 interaction). At 12 weeks, 6-MWT increased in both groups (sacubitril/valsartan: 459 ± 18 to 488 ± 17 meters [6.3%] and enalapril: 443 ± 22 to 477 ± 21 meters [7.7%]). At 24 weeks, sacubitril/valsartan increased 18.3% from baseline (543 ± 26 meters) and enalapril decreased slightly to 6.8% (473 ± 31 meters), but no differences existed between groups (P= .257 interaction). Compared to enalapril, sacubitril/valsartan did not substantially improve peak VO2 or 6-MWT after 12 or 24 weeks in participants with HFrEF. (NEPRIExTol-HF Trial, ClinicalTrials.gov number, NCT03190304).

Fit, Female or Fifty - is cardiac rehabilitation fit for purpose? A systematic review and meta-analysis with meta-regression

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation (CR) is a multi-disciplinary, evidence-based intervention, aimed to address modifiable risk factors for coronary artery disease. It is recommended worldwide for patients following myocardial infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery. A growing body of evidence points towards a lack of uptake in CR in females and younger people. Purpose To examine the effectiveness of contemporary CR programs and assess whether they cater for all patients regardless of age, gender and prior level of fitness, via systematic review, meta-analysis and meta-regression. Methods MEDLINE was examined for studies involving exercise prescription or CR following MI, PCI and cardiac surgery from January 2010 to May 2020. RCTs and cohort studies of ≥10 patients were included for programs delivering phase II or III CR. Primary outcome measures were peakVO2max, 6-minute walk test (6MWT) and Metabolic Equivalent of Task (METs). Data were extracted using random effects meta-analysis. Epidemiological data were analysed for age, proportion of males to females and prior level of fitness. Baseline level of fitness was assessed by peakVO2max, 6MWT and METs values on entry into CR programs. Meta-regression was then used to determine change in fitness and the influence of age or gender. Results Thirty-three of the 713 studies (13 RCT, 20 cohort) were eligible and included in the review. Participants had a mean age of 60.0 years and 6/49 (12%) of study groups had a mean age &amp;lt;55 years. Male participants comprised 81.9% of those who completed CR and 41/58 (71%) participants were below average for cardiorespiratory fitness (CRF) when compared to normative values for those aged 60-69 years on entering CR. CRF improved in all study groups by the end of CR programs (mean improvement in peakVO2 3.3mL/kg/min, 6MWT 90.8m and METs 1.7). Meta-regression analysis showed that males were more likely to have an increase in 6MWT distance compared to females (mean difference 3.16m (95% CI 0.44-5.89). However, gender and age did not independently affect peakVO2max or METs. Conclusion CR following MI, PCI or cardiac surgery improved mean CRF in all study groups. While males were more likely to show an improvement in 6MWT there was no appreciable difference in effect in other outcomes after controlling for age or gender differences. Females, younger people and those of average or above CRF appear to be under-represented in data and attendance at cardiac rehabilitation. Given that CR outcomes are equal across gender and age, more effort should be made to encourage female and younger patients to attend. A ‘Precision Medicine’ model of exercise prescription may assist in this aim.

Efficacy of High-Intensity Intermittent Training for Improving Cardio-Metabolic Health in Women With Polycystic Ovary Syndrome

Abstract Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with significant metabolic and reproductive manifestations, carrying a major health and economic burden. Consistent improvements in clinical outcomes have been reported as a result of exercise training, but shortfalls with exercise prescription are evident. Research suggests that high-intensity intermittent training (HIIT) is feasible, well tolerated and enjoyable for people with or at risk of chronic disease and can address many of the shortfalls and barriers to exercise participation. To investigate the effects of high-intensity exercise on cardio-metabolic health, twenty-four reproductive aged, overweight or obese, sedentary women with PCOS were recruited from the community and randomised to complete either 12 weeks of moderate intensity continuous cycling training (MICT; 60–65% of maximal heart rate [HRmax]; n=11) or HIIT (90–100% HRmax; n=13). All exercise was supervised by an exercise physiologist and completed 3 times per week on a cycle ergometer. Baseline and post-testing measures consisted of peak oxygen consumption (VO2peak) determined by a graded maximal exercise test, body composition by DXA scan and insulin sensitivity determined by euglycaemic-hyperinsulinaemic clamp. Significant improvements in VO2peak were seen after both HIIT (P &amp;lt;0.001) and MICT (P &amp;lt;0.013) with a significant between-group interaction favouring HIIT (P = 0.014). The insulin sensitivity index significantly improved after HIIT (P = 0.009) with no changes observed after MICT (P = 0.860), also resulting in a significant between-group difference favouring HIIT (P = 0.046). No changes were observed for body weight, BMI or fat mass, however, there was a significant increase in percentage of lean mass after HIIT (P = 0.026). The present study is the first to compare current exercise recommendations of moderate and vigorous intensities in women with PCOS. The results of this study provide preliminary validation of HIIT, suggesting that vigorous intensity exercise should be considered in order to improve cardio-metabolic health in women with PCOS.

Training parameters and effects of high-intensity interval training in patients with spinal cord injury: a review of literature

Background Inactivity among patients with spinal cord injury causes further deterioration of cardiorespiratory function and muscle strength. A variety of exercise modes, including high-intensity interval training (HIIT), have been applied to this population to aid them in maintaining good physical and mental health. However, an extensive review of the training parameters and efficacy of HIIT in patients with spinal cord injury remains lacking. Objectives This review aims to summarize the training parameters and effects of HIIT on cardiorespiratory function, muscle architecture, and strength among patients with spinal cord injury. Methods All studies were identified from electronic databases from 2005 to 2020. All articles were reviewed, and data were extracted independently by two reviewers. Risk of bias was assessed using the NIH Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. The methodological quality of randomized control trial (RCT) studies was measured using the PEDro scale. Results A total of 305 studies were identified from all listed databases. After screening, twelve experimental studies comprising three case studies, six quasi-experimental, and three RCTs were selected. Four studies were rated as good, and two studies were rated as fair for the methodology quality of the quasi-experimental study. All three RCT studies scored 5/10 or higher on the PEDro scale. A wide range of training parameters were found for HIIT training. Improvement of VO2peak was reported in seven studies. Information on the effect of HIIT on muscle strength was limited and inconclusive. Conclusion Despite limited evidence, HIIT could be considered effective in improving cardiorespiratory fitness in patients with spinal cord injury. However, whether or not HIIT can significantly improve muscle strength among this population remains inconclusive because of insufficient quality evidence.

Effects of exercise training on redox stress resilience in young and older adults

PurposePerturbations in redox homeostasis can lead to physiological dysfunction and impaired stress resilience. This randomized controlled trial investigated whether aerobic exercise training could improve redox stress resilience measured by the response to a non-exercise redox stressor (forearm ischemia/reperfusion; I/R trial) in young and older men and women. We hypothesized that older adults would have impaired responses to redox perturbations, but that exercise training would reverse the dysfunction. MethodsYoung (18-28yo, n=21) and older (60-77yo, n=19) men and women were randomized to 8-week exercise training (ET; 3 d/wk, 45 min/day) or a non-exercise control group (CON). Aerobic capacity was measured by VO2 peak test on a cycle ergometer. Plasma F2-isoprostane responses to the I/R trial were measured across 7 time points: pre-trial, and 15-, 30-, 60-, 120-, 180-, and 240-minutes post-trial. The I/R trial was completed before and after the 8-week exercise intervention or control arm. ResultsThere were no significant differences in I/R trial responses across age, sex, or groups randomized to training or control. Exercise training significantly improved I/R trial response compared to controls (p<0.01). This improvement was directly related to the degree of improvement in VO2 peak (Pearson correlation r = -0.464, p=0.003). ConclusionsThese data demonstrate that the beneficial effects of moderate exercise in previously inactive adults elicit increased redox capacity that translates to an improved response to a non-exercise redox stressor regardless of age or sex. Furthermore, greater improvements in aerobic fitness resulted in greater resilience to the I/R-induced redox stress. ClinicalTrials.gov IDNCT03419988

Feasibility and adherence to moderate intensity cardiovascular fitness training following stroke: a pilot randomized controlled trial

BackgroundStroke is a leading cause of disability worldwide and the cardiovascular fitness levels of stroke survivors are diminished to an extent that impairs functioning and activities of daily living performance. While cardiovascular training seems an empirically appropriate intervention, the optimal dosage and intensity of cardiovascular training in stroke survivors remains unclear. The aim was to determine the safety and feasibility of moderate-intensity cardiovascular training following stroke, including measurement of adherence to training.MethodsA pilot, prospective, patient- and assessor-blinded randomised controlled trial conducted in a tertiary, metropolitan hospital-based community rehabilitation centre. Eligibility criteria included ambulant (> 100 m), 6 weeks-12 months post stroke. Moderate-intensity fitness training or control (low-intensity) exercise was offered biweekly for 12 weeks. Outcome measures included adverse events, peak oxygen uptake (VO2), functional exercise capacity (6-Minute Walk Test, 10-m Walk Test) and health-related quality of life (Short Form-36) and mood (Patient Health Questionnaire, PHQ9).ResultsFeasibility: Seventy-one (50%) of 141 screened participants were eligible (29% did not agree to participate). Twenty participants (10 intervention, 10 control) were recruited. The median (%; IQR) supervised sessions was 19.5 (81%; 12, 20); and 20 (83%; 19, 22) in the intervention and control groups, respectively. Progression of duration and intensity was limited; mean of 10 sessions to achieve target duration (30 min). There were no adverse events. Baseline peak oxygen uptake (VO2) levels were low (15.94 ml/kg/min). Significant improvements in VO2 peak in both groups were observed (p < 0.05). Although there were no significant between-group differences, this feasibility trial was not powered to detect change.ConclusionsModerate-intensity fitness training was safe but achievement of target duration and intensity was challenging for stroke survivors. A definitive adequately-powered randomised trial is required. Alternative fitness training protocols may need to be explored.Trial registrationThe trial protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN 12613000822785) on 25/07/2013.

Effects of exercise training, with or without supplemental oxygen, in adults with complex congenital heart disease

BackgroundThe number of adults with complex congenital heart disease (ACHD) is increasing and patients are living longer with the condition; therefore, there is a need to investigate lifestyle factors and assess the physical fitness of these patients and to prescribe exercise. We aimed to evaluate the effects of exercise, with or without supplemental oxygen, in patients with complex ACHD. MethodsBetween August 2018 and December 2019, 35 patients were assessed and eight were included in the study. A randomized crossover design was used, and participants were randomized to start exercising with supplemental oxygen (OxyStart) or without (OxyEnd). Muscle function, maximal oxygen uptake (VO2peak), walking distance, physical activity level, patient-reported outcome measures, and blood parameters were assessed. ResultsFour participants were randomized to the OxyStart group (n = 4) and four to the OxyEnd group (n = 4). No-one dropped out of the OxyStart group, but two patients dropped out of in the OxyEnd group. Exercise training resulted in improvements in VO2peak (Δ +1.9 ​ml/kg/min), three of four tests of muscle function, walking distance (Δ +97.5 ​m), and patient-reported outcome measures in participants who completed the study (n ​= ​6). No adverse events occurred during exercise. However, the participants showed diverse responses to oxygen supplementation. ConclusionPatients with complex ACHD benefit from peripheral muscle function exercises. Exercise with supplemental oxygen appears to be safe for such patients but may not affect patients with differing ACHD etiology uniformly; therefore, further studies are required to investigate this.

Pharmacotherapies in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Heart failure (HF) with preserved ejection fraction (HFpEF) causes significant cardiovascular morbidity and mortality. It is a growing problem in the developed world, especially, in the aging population. There is a paucity of data on the treatment of patients with HFpEF. We aimed to identify pharmacotherapies that improve peak oxygen consumption (peak VO2), cardiovascular mortality, and HF hospitalizations in patients with HFpEF.Methods: We conducted a systematic literature search for English studies in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Google scholar. We searched databases using terms relating to or describing HFpEF, stage C HFpEF, and diastolic HF and included only randomized controlled trials (RCTs). RevMan 5.4 (The Cochrane Collaboration, 2020, London, UK) was used for data analysis, and two independent investigators performed literature retrieval and data-extraction. We used PRISMA guidelines to report the outcomes. We included 14 articles in our systematic review and six studies in meta-analysis.Results: We calculated the pooled mean difference (MD) of peak VO2 between placebo and pharmacotherapies. Our meta-analysis showed that the peak VO2 was comparable between pharmacotherapies and placebo in HFpEF (MD = 0.09, 95% CI: −0.11, 0.30, I2 =28%). Our systematic review highlights that statins and spironolactone use should be further studied in larger RCTs due to their potential beneficial effect on all-cause mortality and hospitalizations, respectively.Conclusion: Compared to placebo, none of the pharmacotherapies significantly improved peak VO2 in HFpEF except ivabradine. In our meta-analysis, the pooled improvement in peak VO2 is non-significant. This needs validation with larger studies. We are lacking larger studies on pharmacotherapies that improve peak VO2 in HFpEF. Statin and spironolactone should be further studied in patients with HFpEF as few trials have shown improvement in all-cause mortality and reduction in HF hospitalizations in selected patients, respectively.

Interval training causes the same exercise enjoyment as moderate-intensity training to improve cardiorespiratory fitness and body composition in young Chinese women with elevated BMI

ABSTRACT This study examined the effects of 12 weeks of sprint interval training (SIT), high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on cardiorespiratory fitness (peak oxygen uptake, VO2peak), body composition and physical activity enjoyment in overweight young women. Sixty-six participants (age 21.2 ± 1.4 years, body mass index (BMI) 26.0 ± 3.0 kg·m−2, body fat percentage 39.0 ± 2.8%) were randomly assigned to non-exercise control (CON), thrice-weekly SIT (80 × 6 s “all-out” cycling interspersed with 9 s rest), and HIIT (4 min cycling at 90% VO2peak followed with 3 min recovery for ~ 60 min) or MICT (~ 65 min continuous cycling at 60% VO2peak) with equivalent mechanical work (200/300 KJ). Compared to the CON group, all three training groups had significant and similar improvements in VO2peak (~ +20%, d = 2.5–3.4), fat mass (~ −10%, d = 1.3–2.1) and body fat percentage (~ −5%, d = 1.0–1.1) after a 12-week intervention. Similar high levels of enjoyment were observed among groups for most (~70%) of the training sessions. The findings suggest that the three training regimes are equally enjoyable and could result in similar improvements in cardiorespiratory fitness and body composition in overweight/obese young women, but SIT is a more time-efficient strategy.

Endurance Training Improves Oxygen Uptake and Endurance Capacity in Patients With Moderate to Severe Valvular Disease.

Aim: Peak oxygen uptake (peakVO2) is one of the strongest predictors of survival in patients with valvular heart disease. The purpose of this study was to determine whether endurance training improves peakVO2 and endurance capacity in patients with moderate-severe aortic and mitral valve disease.Methods: 30 patients with moderate-severe valvular heart disease were randomly assigned to 12 weeks of endurance training (TG) (n = 16) or standard care (SC) (n = 14). PeakVO2 and maximum working capacity (Wattmax) were assessed by cardiopulmonary exercise testing, as well as submaximal endurance test at 80% of peakVO2 at baseline and after 12 weeks.Results: There was a significant improvement in peakVO2 from 27.2 ± 5.9 ml/kg to 30.4 ± 6.3 ml/kg (P < 0.001) in TG compared to the SC (peakVO2 from 24.6 ± 4.4 to 24.7 ± 3.8) and in the Wattmax from 151.8 ± 41.0 Watt to 171.2 ± 49.7 Watt in the TG compared to the SC (152.9 ± 35.6 Watt to 149.2 ± 28.4 Watt). The endurance capacity increased significantly from 17.0 ± 9.4 min to 32.8 ± 16.8 min (p = 0.003) in the TG compared to the SC (11.7 ± 6.2 min to 11.2 ± 7.6 min). The heart rate during the endurance test decreased in the TG from 154 ± 14 b/min to 142 ± 20 b/min for the same workload. No changes could be seen in the SC.Conclusion: Endurance training in patients with moderate to severe valvular heart disease increased significantly the peakVO2 as well as the endurance capacity.

Aerobic, Resistance, and Combination Training on Health-Related Quality of Life: The STRRIDE-AT/RT Randomized Trial.

Purpose: The main purpose of this study was to determine the differential effects of aerobic training (AT), resistance training (RT), and a combination of aerobic and resistance training (AT/RT) on changes in self-rated HrQoL measures, including the Short-Form 36 (SF-36) survey and Satisfaction with Physical Function and Appearance survey. We also sought to determine if combination training (AT/RT) has a more or less additive effect compared to AT or RT alone on self-rated HrQoL measures.Materials and Methods: Participants (n = 137) completed one of three 8-month exercise interventions: (1) AT: 14 kcal exercise expenditure per kg of body weight per week (KKW; equivalent to roughly 12 miles/week) at 65–80% of peak oxygen consumption; (2) RT: 3 days per week, 8 exercises, 3 sets per exercise, 8–12 repetitions per set; (3) AT/RT: full combination of the AT and RT interventions. The SF-36 survey, Satisfaction with Physical Function and Appearance survey, physical fitness, and anthropometrics were assessed at baseline and post-intervention. Paired t-tests determined significant pre- vs. post-intervention scores within groups (p < 0.05). Analyses of covariance determined differences in change scores among groups (p < 0.05).Results: On average, participants were 49.0 ± 10.6 years old, obese (BMI: 30.6 ± 3.2 kg/m2), female (57.7%), and Caucasian (84.7%). Following the 8-month intervention, exercise groups improved peak VO2 (all groups), strength (RT and AT/RT), and anthropometric measures (AT and AT/RT). For the SF-36, RT (p = 0.03) and AT/RT (p < 0.001) significantly improved their physical component score; only AT/RT (p < 0.001) significantly improved their mental component score. Notably, all groups significantly improved both their satisfaction with physical function and appearance scores (All Groups: p < 0.001 for both outcomes).Conclusions: We found that aerobic, resistance, or combination exercise training improves several components of self-rated HrQoL, including physical function, appearance, and mental well-being.Clinical Trial Registration: No. NCT00275145.

Inspiratory Muscle Training in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis

ObjectivesTo explore the role of inspiratory muscle training (IMT) in improving cardiorespiratory fitness of stable heart failure with preserved ejection fraction (HFpEF) patients.BackgroundThere is a paucity of data on the role of IMT in patients with HFpEF. HFpEF is a growing problem in the developed world, especially in the aging population.MethodsWe conducted a systematic literature search for English studies in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. We searched databases using terms relating to or describing breathing exercise, IMT, and HFpEF. RevMan 5.4 (The Cochrane Collaboration, 2020) was used for data analysis, and two independent investigators performed literature retrieval and data extraction.ResultsWe identified three randomized controlled trials (RCTs) and one prospective study on the role of IMT in HFpEF. We calculated the pooled mean difference of peak oxygen consumption (Peak VO2) and six-min walk distance (6MWD) between the IMT and standard care (SC) groups. Our meta-analysis showed that compared with SC, IMT could significantly improve peak VO2 with a mean difference (MD) of 2.82 ml/kg/min, 95% CI [1.90, 3.74] P < 0.00001 and improve 6MWD with MD of 83.97 meters, 95% CI [59.18, 108.76] P< 0.00001 to improve cardiorespiratory fitness at 12 weeks of IMT and improve peak VO2 with MD of 2.18 ml/kg/min, 95% CI [0.38, 3.99] P < 0.00001 at 24 weeks of therapy.ConclusionIMT should be further studied as a possible treatment option to improve cardiorespiratory fitness for patients with stable HFpEF.

Concurrent training effects on heart rate variability, blood pressure and fitness of middle-aged men and women

The concurrent training led to beneficial effects on aerobic fitness and muscle strength. However, its effects on blood pressure (BP) and autonomic control marks are little studied. This study aimed to evaluate the concurrent training effects on BP, autonomic control, aerobic fi tness and muscle strength of middle-aged men and women. Thirty-two volunteers (51.4 ± 4.2 years, systolic BP 115 ± 12 mmHg and diastolic BP 78 ± 8 mmHg) were divided into 4 groups of 8 volunteers: male concurrent training (MCT), female concurrent training (FCT), male sedentary control (MSC) and female sedentary control (FSC) groups. A minimum absence of menstruation for 12-months was required. Concurrent training, six resistance exercise for whole body followed by 30 min of jogging and/or running at 55%–85% of VO2peak, was performed three times a week. The main assessments were rest BP and cardiovascular autonomic markers evaluated through heart rate variability (iRR, LF, HF, LF/HF, RMSSD, pNN50, SD1 and SD2), aerobic fitness measured by cardiorespiratory test (VO2peak) and muscle strength by one repetition maximum (1-RM - arm curl, bench press and leg press). The concurrent training did not change any cardiovascular variables. Regarding fitness the MCT and FCT groups demonstrated signifi cant improvement in VO2peak (13.12% e 8.51%, respectively). Muscle strengthimproved significantly in the MCT group in all three exercises (arm curl: 26.53%; bench press: 25.04%; leg press: 65.37%), while FCT in just two exercises (arm curl: 12.79%; bench press: 17.25%). Although concurrent training appears to be a good alternative for inducing improvements in various physical fitnessvariables in male, its can induce concurrence in leg strength of female. Concurrent training is not an effective strategy to improve BP and autonomic nervous system.

Abstract 14404: The Fontan Udenafil Exercise Longitudinal Trial Subgroup Analysis

Background: The Pediatric Heart Network’s Fontan Udenafil Exercise Longitudinal (FUEL) Trial (Mezzion Pharma Co. Ltd., NCT 02741115) demonstrated improvements in exercise capacity and ventricular performance following six months of treatment with udenafil (87.5 mg twice daily). In this analysis we evaluated whether subgroups within the population experienced a differential effect on exercise performance in response to treatment. Methods: The effect of udenafil on exercise was evaluated within subgroups defined by gender, race, ventricular morphology, and baseline peak oxygen consumption (VO 2 ). Linear regression modeling evaluated for differential response to udenafil (interaction of subgroup with treatment arm). Individual subgroups were excluded if the number of participants was &lt;5% of total. As the FUEL Trial was not powered for subgroup analysis, all analyses were viewed as exploratory. Results: Subgroup analyses demonstrated qualitative improvements in peak VO 2 , work rate at the ventilatory anaerobic threshold (VAT), VO 2 at VAT, and ventilatory efficiency (VE/VCO 2 ) for those randomized to udenafil compared to placebo in all subgroups (Table). There was not a differential response to udenafil based on gender, race, ventricular morphology, or baseline peak VO 2 , although participants in the lowest tertile of baseline peak VO 2 and those with single left ventricles trended toward larger improvements. Conclusion: The relatively uniform improvement among subgroups in response to treatment with udenafil is consistent with the findings from the primary analysis of the FUEL trial. While the absence of a statistically significant differential effect between subgroups suggests that the effect of udenafil may not be gender, race, or morphology specific, and may not vary based on baseline exercise performance, the possibility of a larger improvements in those with poor baseline peak VO 2 and those with single left ventricle warrants further investigation.

Prognostic markers in patients undergoing transcatheter implantation of Venus P-valve: Experience in Taiwan

Prognostic factors remain unclear in patients undergoing transcatheter implantation of Venus P-valve for their severe pulmonary regurgitation associated with native right ventricular (RV) outflow tract. Between January 2017 and October 2018, we prospectively collected data of patient characteristics, cardiac magnetic resonance imaging, cardiopulmonary exercise testing, and levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) before and 6-12 months after valve graft implantation. Fifteen patients (male: 8, median age: 24.8 years) were enrolled. The procedure success rate was 100%. The median follow-up was 16.3 months without any dysfunction of the valve graft. The cohort demonstrated a significant improvement in cardiac index (from 3.3 to 3.9L/min/m2) and increase of percentage of New York Heart Association functional class I (P<10-3), reduction in RV end-diastolic volume index (P=0.008), and reductions in NT-proBNP levels (from 78.9 to 45.8pg/mL, P=0.040). However, the peak oxygen consumption (VO2) dropped from 50.2% to 48.5% of the predicted value. Interestingly, we determined that patients with NT-proBNP levels below 70pg/mL and left ventricular end-diastolic pressure (LVEDP) below 11mmHg had a significantly higher chance of exhibiting improvement in peak VO2 compared with those without (3/4 vs 1/10, P=0.041). In the small cohort with severe pulmonary regurgitation, implantation of a Venus P-valve led to promising reductions in RV volume. However, no definite improvement in cardiopulmonary exercise capacity or RV ejection fraction was achieved. Levels of NT-proBNP and LVEDP may be helpful for refining the indications of the Venus P-valve implantation.

Do socioeconomic status and ethnicity predict CR outcomes in coronary heart disease patients in Denmark?

Abstract Background Cardiac patients with low socioeconomic status and other ethnic background have worse prognosis and outcomes. Cardiac rehabilitation (CR) has the potential to diminish this socioeconomic and ethnical disparity, but evidence is lacking. Purpose To describe if socioeconomic status and ethnicity predicts CR outcomes in coronary heart disease (CHD) patients in Denmark. Methods The study is based “The Danish Cardiac rehabilitation database” (DHRD) which monitors quality of CR in Denmark. The study population are all patients with CHD (myocardial infarction or stable coronary artery disease with revascularization or medical treatment) participating in CR reported to the database from Aug 2015 to Mar 2018. The quality indicators (QI) were &amp;gt;80% participation in exercise sessions, &amp;gt;10% increase in VO2peak, smoking cessation, LDL &amp;lt;1.8mmol/L (or 50% reduction of baseline LDL), blood pressure &amp;lt;140/90, dietary consulting, screening for diabetes, screening for depression and medical treatment with acetylsalicylic acid, statins and beta-blockers at completion of CR. Educational level as a marker for socioeconomic status was divided into no-, basic-, medium- and high education, and ethnicity into Danish, Western and non-western origin. We compared QI across educational level and ethnicity using descriptive statistics. Results Analyses are based on 9000 patients. Age and gender differed significantly in the groups (all p&amp;lt;0.001). Medical treatment and achievement of LDL- and blood pressure control was overall good with no difference across socioeconomic strata or ethnicity. Despite similar participation rate, higher education was associated with greater improvements in VO2peak. Patients of non-western ethnicity were less often screened for depression and less often received dietary consulting. Conclusion In this nationwide quality database for CR, medical treatment and achievement of traditional risk factor goals was good across socioeconomic and ethnic strata. However, outcome in VO2peak and implementation of screening for depression and diabetes showed disparity across socioeconomic and ethnic groups. The effect on long-term outcomes remains to be addressed. Funding Acknowledgement Type of funding source: None

Haemodynamic determinants of improved aerobic capacity after tricuspid valve surgery in Ebstein anomaly

BackgroundAlthough tricuspid valve surgery improves functional capacity in patients with Ebstein anomaly, it is not always associated with improvement in aerobic capacity. The purpose of this study was to identify...

Correlation Between Exercise-Induced Increases in VO2 Peak and Motor/Cognitive Ability in Sedentary Older Adults

To determine if post-intervention improvements in VO2 peak, an indicator of cardiovascular fitness, were correlated with changes in motor skills and cognitive abilities in older adults.

A randomized controlled trial of a structured exercise intervention after the completion of acute cancer treatment in adolescents and young adults.

Cancer treatments are frequently associated with impaired physical fitness, quality of life (QOL), and fatigue, often persisting into survivorship. Studies in older adults with cancer have demonstrated benefits from exercise; however, this has not been rigorously investigated in adolescents and young adults (AYA). The aim of this study was to determine whether a structured 10-week exercise intervention was associated with improved cardiorespiratory fitness (VO2peak ), fatigue, and QOL in AYA who have recently completed cancer treatment. Forty-three AYA (median age 21 ± 6 years) were randomly assigned to an exercise group (n=22) or a control group (n=21). The exercise group received a structured 10-week exercise program comprising progressive aerobic and resistance exercise; the control arm received routine care. VO2peak was measured at baseline, 10weeks, and six months. Fatigue and QOL were assessed by the FACIT fatigue scale and the PEDS QL, respectively. Mean VO2peak at baseline was 26.5 ± 7.2mL.kg-1 .min-1 , which is substantially lower than population norms. The exercise group demonstrated significant improvement in VO2peak at 10weeks compared with controls (33.8 ± 8.1vs 29.6 ± 7.6mL.kg-1 .min-1 , P=0.0002), but by six months, the difference was no longer significant (32.9 ± 7.0vs 30.9 ± 11.0mL.kg-1 .min-1 , P=0.21). There were no significant differences in fatigue or total QOL scores between groups. Cancer treatment is associated with reduced VO2peak in AYA. Improvement in VO2peak was accelerated by a 10-week exercise program; however, no significant benefit was observed in QOL or fatigue. The plateau in VO2peak at six months suggests that a maintenance exercise program may be beneficial.

Combined resistance and aerobic exercise intervention improves fitness, insulin resistance and quality of life in survivors of childhood haemopoietic stem cell transplantation with total body irradiation

To investigate the effects of a supervised combined resistance and aerobic training programme on cardiorespiratory fitness, body composition, insulin resistance and quality of life (QoL) in survivors of childhood haematopoietic stem cell transplantation (HSCT) with total body irradiation (TBI). HSCT/TBI survivors (n=20; 8 females). Mean (range) for age at study and time since HSCT/TBI was 16.7 (10.9-24.5) and 8.4 (2.3-16.0) years, respectively. After a 6-month run-in, participants undertook supervised 45- to 60-minute resistance and aerobic training twice weekly for 6 months, with a 6-month follow-up. The following assessments were made at 0, 6 (start of exercise programme), 12 (end of exercise programme) and 18 months: Body composition via dual energy X-ray absorptiometry, homeostatic model assessment of insulin resistance (HOMA-IR), cardiorespiratory fitness (treadmill-based peak rate of oxygen uptake (VO2 peak) test), QoL questionnaires (36-Item Short Form Health Survey (SF-36) and Minneapolis-Manchester Quality of Life Instrument (MMQL). Results expressed as mean (standard deviation) or geometric mean (range). There were significant improvements in VO2 peak (35.7 (8.9) vs 41.7 (16.1) mL/min/kg, P=0.05), fasted plasma insulin (16.56 (1.48-72.8) vs 12.62 (1.04-54.97) mIU/L, P=0.03) and HOMA-IR (3.65 (0.30-17.26) vs 2.72 (0.22-12.89), P=0.02) after the exercise intervention. There were also significant improvements in the SF-36 QoL general health domain (69.7 (14.3) vs 72.7 (16.0), P=0.001) and the MMQL school domain (69.1 (25.2) vs (79.3 (21.6), P=0.03) during the exercise intervention. No significant changes were observed in percentage body fat, fat mass or lean mass. The supervised 6-month combined resistance and aerobic exercise programme significantly improved cardiorespiratory fitness, insulin resistance and QoL in childhood HSCT/TBI survivors, with no change in body composition, suggesting a metabolic training effect on muscle. These data support a role for targeted physical rehabilitation services in this group at high risk of diabetes and cardiovascular disease.